Asymptomatic portal vein aneurysms: To treat, or not to treat?

2017 ◽  
Vol 33 (8) ◽  
pp. 513-516 ◽  
Author(s):  
Sameer A Hirji ◽  
Faith C Robertson ◽  
Sergio Casillas ◽  
James T McPhee ◽  
Naren Gupta ◽  
...  
Keyword(s):  
Portal Vein ◽  
Surgical Intervention ◽  
Thrombus Formation ◽  
Portal Venous System ◽  
Diagnostic Challenge ◽  
Portal Vein Aneurysm ◽  
Routine Surveillance ◽  
Aneurysm Detection ◽  
Small Aneurysms

Background Portal vein aneurysms are rare dilations in the portal venous system, for which the etiology and pathophysiological consequences are poorly understood. Method We reviewed the existing literature as well as present a unique anecdotal case of a patient presenting with a very large portal vein aneurysm that was successfully managed conservatively and non-operatively without anticoagulation, with close follow-up and routine surveillance. Result The rising prevalence of abdominal imaging in clinical practice has increased rates of portal vein aneurysm detection. While asymptomatic aneurysms less than 3 cm can be clinically observed, surgical intervention may be necessary in large asymptomatic aneurysms (>3 cm) with or without thrombus, or small aneurysms with evidence of evolving mural thrombus formation on imaging. Conclusion Portal vein aneurysms present a diagnostic challenge for any surgeon, and the goal for surgical therapy is based on repairing the portal vein aneurysm, and if portal hypertension is present decompressing via surgically constructed shunts.

scholarly journals Repeated Plastic Stentings of Common Hepatic Duct for Portal Vein Aneurysm Compression in a Patient Unsuitable for Surgery

2018 ◽  
Vol 12 (3) ◽  
pp. 570-577 ◽  
Author(s):  
Jeffrey Sun ◽  
Cheuk-Kwan Sun ◽  
Cheuk-Kay Sun
Keyword(s):  
Portal Vein ◽  
Surgical Intervention ◽  
Vascular Malformations ◽  
Imaging Modality ◽  
Hepatic Duct ◽  
Therapeutic Option ◽  
Clinical Signs ◽  
Common Hepatic Duct ◽  
Low Grade ◽  
Portal Vein Aneurysm

Portal vein aneurysms are rare vascular malformations with unclear etiologies and optimal treatment guidelines. Although Doppler ultrasonography is the most commonly used diagnostic tool, there is no gold standard imaging modality. Despite recommendations of surgical treatment for symptomatic aneurysms, there are limited options in the management of portal vein aneurysm-related complications in patients unfit for surgical intervention. We describe an 85-year-old man who presented with abdominal pain and low-grade fever with clinical signs consistent with cholangitis. Endoscopic retrograde cholangiopancreatography revealed a common hepatic duct stricture and concomitant intraductal ultrasonography identified adjacent aneurysmal portal vein dilatation. The final diagnosis of portal vein aneurysm was made using contrast computerized tomography scan. The patient was considered unsuitable for surgery due to his advanced age and multiple comorbidities. Instead, an endoscopic biliary plastic stent was inserted as a therapeutic alternative, which successfully achieved complete resolution of symptoms 3 days after the procedure. The patient was regularly followed at the outpatient clinic with repeated stent replacements every 3 to 4 months. After a follow-up of over 3.5 years, the patient remained symptom-free without signs of portal vein aneurysm compression. The result suggests that repeated stent replacements may be a therapeutic option for biliary compression by portal vein aneurysm in patients contraindicated for surgical intervention.

scholarly journals Ultrasonography and 3D-CT Follow-Up of Extrahepatic Portal Vein Aneurysm: A Case Report

2010 ◽  
Vol 2010 ◽  
pp. 1-6 ◽  
Author(s):  
Norio Yukawa ◽  
Makoto Takahashi ◽  
Kazuyoshi Sasaki ◽  
Takuma Mori ◽  
Ayumi Matsuo ◽  
...  
Keyword(s):  
Portal Vein ◽  
English Language ◽  
Color Doppler ◽  
Diagnostic Techniques ◽  
3D Ct ◽  
Portal Vein Aneurysm ◽  
Hepatic Hilum ◽  
Color Doppler Us ◽  
Abdominal Fullness

Extrahepatic portal vein aneurysm is a rare disorder. From 1956 to 2008, we found only 43 published English-language reports, including 67 cases, using Pub Med. We report a case of a 77-year-old woman who had complaints of lower abdominal fullness and residual urine. We performed ultrasonography (US), which demonstrated a congenital extrahepatic portal vein aneurysm. She had no obvious symptoms of the extrahepatic portal vein aneurysm. She had undergone gastrectomy without blood transfusion for gastric ulcer more than 20 years ago. Physical examination revealed no abnormal findings. US revealed a2.2×1.8 cm, round shaped hypoechogenic lesion at the hepatic hilum. Color Doppler US showed bidirectional colors due to circular flow within this lesion. 3D-CT and CT angiography demonstrated that the saccular aneurysm at the hepatic hilum was 3.0 cm in diameter and was enhanced equal to that of portal vein.Twenty-six months after the diagnosis, the aneurysm had not grown in size. Since our patient had no serious complaints or liver disease, surgical procedures had not been employed. US and 3D-CT are noninvasive diagnostic techniques and are helpful in the diagnosis and follow-up of extrahepatic portal vein aneurysms.

scholarly journals The Management of Extrahepatic Portal Vein Aneurysms: Observe or Treat?

HPB Surgery ◽  
1996 ◽  
Vol 10 (2) ◽  
pp. 113-116 ◽  
Author(s):  
Philip D. Feliciano ◽  
Joseph J. Cullen ◽  
John D. Corson
Keyword(s):  
Portal Hypertension ◽  
Liver Disease ◽  
Portal Vein ◽  
Process Management ◽  
Asymptomatic Patient ◽  
Underlying Liver Disease ◽  
Surgical Exploration ◽  
Portal Vein Aneurysm

A case of a 70 year old man who was found to have an extrahepatic portal vein aneurysm during an evaluation for hematuria is reported. Extrahepatic portal vein aneurysms are rare with only twenty cases reported in the literature. Typically, patients present with hemorrhage requiring surgical exploration or the aneurysm is discovered during evaluation of another abdominal process. Management includes careful follow-up in the asymptomatic patient without underlying liver disease or portal hypertension.

Imaging features and follow-up of large extrahepatic portal vein aneurysm

2013 ◽  
Vol 1 (3) ◽  
pp. 309-310
Author(s):  
Olivier Varbédian ◽  
Louis Estivalet ◽  
Karine Peignaux ◽  
Romaric Loffroy
Keyword(s):  
Portal Vein ◽  
Imaging Features ◽  
Portal Vein Aneurysm

Diagnosis and surgical treatment of extrahepatic portal vein aneurysm: A case report

Vascular ◽  
2014 ◽  
Vol 23 (5) ◽  
pp. 553-554 ◽  
Author(s):  
Hao He ◽  
Constantine N Antonopoulos ◽  
Konstantinos G Moulakakis ◽  
George S Sfyroeras ◽  
John D Kakisis ◽  
...  
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
Portal Vein ◽  
Surgical Intervention ◽  
Main Trunk ◽  
Postoperative Course ◽  
Portal Vein Aneurysm

Extrahepatic portal vein aneurysm is a relatively uncommon entity. We reported the case of a 51-year-old man, who was incidentally diagnosed with an asymptomatic 52 × 65 mm portal vein aneurysm, which was located at the main trunk of the portal vein, just before its bifurcation. The patient was treated with partial clamping of the portal vein aneurysm and aneurysmorrhaphy. Postoperative course was uneventful. Surgical intervention should be considered for patients with large, symptomatic or expanding portal vein aneurysms.

scholarly journals Saccular portal vein aneurysm complicating laparoscopic cholecystectomy

2021 ◽  
Author(s):  
Haider Rasheed ◽  
Mohammed Abed ◽  
Duraid Mahmoud Jamil
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Portal Vein ◽  
Color Doppler ◽  
Portal Vein Aneurysm ◽  
Doppler Study ◽  
Uncertain Etiology

Portal vein aneurysm (PVA) is a rare vascular entity of uncertain etiology. Saccular PVA is the less frequently reported morphology but often with more symptoms or complications. Ultrasound, along with color doppler study, is a valuable tool in the diagnosis and follow-up.

Autoimmune Pancreatitis – Diagnosis, Management and Longterm Follow-up

2014 ◽  
Vol 23 (2) ◽  
pp. 179-185 ◽  
Author(s):  
Suvadip Chatterjee ◽  
Kofi W. Oppong ◽  
John S. Scott ◽  
Dave E. Jones ◽  
Richard M. Charnley ◽  
...  
Keyword(s):  
Autoimmune Pancreatitis ◽  
Rare Condition ◽  
Team Approach ◽  
Diagnostic Challenge ◽  
Multisystem Disorder ◽  
North East ◽  
The North ◽  
Work Up ◽  
Igg4 Level

Background & Aims: Autoimmune pancreatitis (AIP) is a fibroinflammatory condition affecting the pancreas and could present as a multisystem disorder. Diagnosis and management can pose a diagnostic challenge in certain groups of patients. We report our experience of managing this condition in a tertiary pancreaticobiliary centre in the North East of England.Methods: Patients were identified from a prospectively maintained database of patients diagnosed with AIP between 2005 and 2013. Diagnosis of definite/probable AIP was based on the revised HISORt criteria. When indicated, patients were treated with steroids and relapses were treated with azathioprine. All patients have been followed up to date.Results: Twenty-two patients were diagnosed with AIP during this period. All patients had pancreatic protocol CT performed while some patients had either MR or EUS as part of the work up. Fourteen out of 22 (64%) had an elevated IgG4 level (mean: 10.9 g/L; range 3.4 - 31 g/L). Four (18%) patients underwent surgery. Extrapancreatic involvement was seen in 15 (68%) patients, with biliary involvement being the commonest. Nineteen (86%) were treated with steroids and five (23%) required further immunosuppression for treatment of relapses. The mean follow up period was 36.94 months (range 7 - 94).Conclusion: Autoimmune pancreatitis is being increasingly recognized in the British population. Extrapancreatic involvement, particularly extrahepatic biliary involvement seems to be a frequent feature.Diagnosis should be based on accepted criteria as this significantly reduces the chances of overlooking malignancy. Awareness of this relatively rare condition and a multi-disciplinary team approach will help us to diagnose and treat this condition more efiectively thereby reducing unnecessary interventions.

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